BMC primary care最新文献

{"title":"The Healthy Hearts program to improve primary care for hypertension in seven rural health units of Iloilo Province, Philippines: a comparative cost study.","authors":"Hilton Y Lam, Haidee A Valverde, Doris Mugrditchian, Muhammad Jami Husain, Soumava Basu, Bishal Belbase, Rauell John Santos, Dofel Joseph Calla, Tyrone Aquino, Andrew E Moran, Deliana Kostova","doi":"10.1186/s12875-025-02758-5","DOIUrl":"10.1186/s12875-025-02758-5","url":null,"abstract":"<p><strong>Background: </strong>In 2021, the Philippines launched the Healthy Hearts demonstration project for delivering hypertension (HTN) services in seven Rural Health Units (RHUs) in District 1 of Iloilo Province, West Visayas Region. This study evaluates the provider time cost and medication cost of delivering these services under three medication procurement scenarios, projecting them to the district and province levels to inform scaling-up efforts.</p><p><strong>Methods: </strong>A mixed-methods design was used for cost data collection, including key informant interviews (KII), focus group discussions (FGD), and secondary data sources. The HEARTS costing tool was adapted to analyze program costs per patient from the health system perspective. Three scenarios were assessed, depending on the procurement scheme of HTN medications: baseline local government procurement, pooled procurement through the Philippine Pharma Procurement Inc. (PPPI) national pooling mechanism, and private pharmacy outsourcing. We assessed annual provider labor costs and medication costs per patient for each scenario.</p><p><strong>Results: </strong>The average provider cost per patient was considerably lower for patients with controlled HTN than for patients with uncontrolled HTN: USD 5 (range USD 3.4-6.1 across RHUs) vs. USD 32.9 (range USD 28.8-38.4)) due to the need for more frequent follow-up visits for the latter. Average medication costs per patient were estimated at USD 9.1 (range USD 7.2-11.5) using local procurement prices, USD 2.9 (range USD 2.3-3.7) using PPPI pooled procurement prices, and USD 23 (range USD 17.9-30.5) using private pharmacy outsourced prices. The higher medicine costs in the pharmacy outsourcing scenario were partially offset by lower provider costs (an average reduction of USD 1.5 per patient per year) due to reduced on-site dispensing time in this scenario.</p><p><strong>Conclusions: </strong>The findings from this study indicate two key opportunities for cost savings in HTN management in the Philippines' rural health units system: 1) enhancing the control of HTN, thereby reducing the need for follow-up visits and cutting down on provider time costs, and 2) utilizing pooled medication procurement mechanisms such as through the Philippine Pharma Procurement Inc. Provider time costs can also be partially reduced through outsourcing the dispensing of medications to private pharmacies, although doing so is currently associated with higher medication costs, further underscoring the utility of pooled procurement mechanisms for essential hypertension medicines.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"80"},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions, approaches, and needs of Czech GPs in the management of patients with persistent somatic symptoms: the results of a nationwide cross-sectional survey.","authors":"Martin Seifert, Antonin Sebela, Tim Olde Hartman","doi":"10.1186/s12875-025-02768-3","DOIUrl":"10.1186/s12875-025-02768-3","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) perceive patients with persistent somatic symptoms (PSS) as frustrating and difficult to manage. Patients commonly express dissatisfaction with the care they receive and often feel stigmatised and not taken seriously. Some Czech GPs use the option of extra psychosomatic education which focuses on better understanding and management of patients with PSS.</p><p><strong>Objectives: </strong>To explore perceptions of Czech GPs, with and without additional psychosomatic training, regarding the care of patients with PSS, their beliefs, approaches in the management, and their organisational and educational needs.</p><p><strong>Methods: </strong>A nationwide cross-sectional survey study among Czech GPs exploring experiences, perceptions, and needs in managing patients with PSS was conducted. Statistical and qualitative approaches were performed to analyse the data.</p><p><strong>Results: </strong>A total of 152 GPs (37 with and 115 without additional psychosomatic training) participated in this survey (response rate 20,3%). GPs struggle with negative emotions, communication with patients, diagnostic uncertainty, patients' lack of understanding, the workload these patients generate, lack of specialized care, and other problems of the healthcare system. They call for more psychosomatic education and communication training. This should include theoretical explanatory models, Balint groups, and other kinds of supervision or peer groups. GPs with additional psychosomatic training feel more confident and competent caring for these patients, compared to GPs without such additional training (OR = 4.1; 95% CI = 1.85-9.11); p < 0.005). Furthermore, they view PSS patients as less burdensome (OR = 4.69; 2.11-10.4; p < 0.001).</p><p><strong>Conclusions: </strong>GPs struggle with caring for patients with PSS. GPs with additional psychosomatic education indicate that they have more confidence and competence. Czech GPs call for more time and reimbursement when caring for patients with PSS, more psychosomatic training, better availability of specialized psychosomatic care, and better interdisciplinary cooperation.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"79"},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative RE-AIM evaluation of an embedded community paramedicine program in an Ontario Family Health Team.","authors":"Sarisha Philip, Lauren Konikoff, Samuel Tiukuvaara, Tracey Izzard, Kyle Sitka, Ghislain Bercier, Kimberley Hewton, Barry Bruce, Mark Fraser, Karen Ferguson, Chris LeBouthillier, Courtney Maskerine, Krystal Kehoe MacLeod","doi":"10.1186/s12875-025-02777-2","DOIUrl":"10.1186/s12875-025-02777-2","url":null,"abstract":"<p><strong>Background: </strong>In 2014, a rural Family Health Team (FHT) in Ontario, Canada embedded a community paramedicine program into their primary care practice to improve care for their complex patients. Community paramedics are health care professionals who extend their role beyond emergency services to provide primary care in home and community settings. The study aims to evaluate the utility of having community paramedics embedded in a rural FHT.</p><p><strong>Methods: </strong>In this qualitative study, we conducted 12 semi-structured interviews with the community paramedicine team (n=4) and other staff from the FHT (n=8), including physicians, nurse practitioners, allied health professionals (AHPs), and the program director. We conducted a deductive and thematic analysis using the RE-AIM framework. This allowed us to examine the strengths and challenges of incorporating community paramedics in a primary care model for providers and coordinating patient care in a rural setting.</p><p><strong>Results: </strong>Reach: The community paramedicine program is primarily used by physicians to target older patients with multiple chronic conditions, frequent health care use, and limited social support.</p><p><strong>Effectiveness: </strong>In-home visits by community paramedics yield a detailed picture of patients' health-related behaviours, such as medication adherence and dietary habits, improving the FHT's understanding of patient needs and informing care strategies. Adoption: Community paramedics value the opportunity to build long-lasting patient relationships.</p><p><strong>Implementation: </strong>The FHT's rural location is a significant external barrier limiting the paramedic program's ability to serve a larger patient caseload. Maintenance: The program aligns with the FHT's mission to improve access to care for vulnerable patients.</p><p><strong>Conclusions: </strong>Our findings highlight community paramedics' role in supporting high-needs patients, particularly in rural settings. The average age of patients in the program is 78, and they often have multiple comorbidities, including prevalent dementia. Such health conditions necessitate home visits to gather accurate health information often masked in clinic settings. Embedding community paramedics in a primary care model improves access to care and provides more support for patients with complex needs. Using these findings, we developed a \"how to\" blueprint for embedding community paramedics in primary care settings to address the care needs of high-risk older adults.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"82"},"PeriodicalIF":2.0,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake of patient enrolment in primary care and associated factors: a systematic review and meta-analysis.","authors":"Jialing Lin, Shona Bates, Luke N Allen, Michael Wright, Limin Mao, Rafal Chomik, Chris Dietz, Michael Kidd","doi":"10.1186/s12875-025-02779-0","DOIUrl":"10.1186/s12875-025-02779-0","url":null,"abstract":"<p><strong>Background: </strong>Patient enrolment in primary care refers to the formal process of registering patients with a specific primary care provider, team, or practice. This approach is often expected to enhance continuity and coordination of care. However, limited information exists on the uptake of patient enrolment and its associated characteristics. This review aimed to estimate the uptake of patient enrolment in primary care and examine factors associated with decisions around enrolment.</p><p><strong>Methods: </strong>Eight electronic databases (PubMed, Cochrane Register of Systematic Reviews, Embase, CINAHL, PsycINFO, PAIS, Web of Science, and Scopus) were searched for peer-reviewed articles published from January 2014 to July 2024. Findings from included studies were extracted and synthesised, with uptake estimated through meta-analysis and factors associated with enrolment summarised narratively.</p><p><strong>Review registration: </strong>PROSPERO CRD42024597078.</p><p><strong>Results: </strong>Ten studies across nine publications were included. Of these, eight studies with 27,919,216 participants were included in the meta-analysis. The results showed a pooled patient enrolment uptake rate of 71.4% (95% Confidence Interval [CI]: 13.6-97.5%). There was no significant difference in enrolment rates between population-wide and program-based enrolment (72.4% vs. 73.5%; p = 0.980). Several associated factors were identified in three publications. Women showed higher enrolment rates than men (adjusted odds ratio [aOR] = 1.07, 95% CI: 1.07-1.08), while recently arrived immigrants in a country had lower enrolment rates than the established population (aOR = 0.40, 95% CI: 0.40-0.41). Patients living in small urban/suburban/rural areas had higher enrolment rates than those in large urban/metropolitan regions (aORs: 1.17-2.18). Higher socioeconomic level was associated with increased rates of enrolment. Patients with some specific chronic health conditions, such as those with diagnosed mental illness or substance use disorders, had lower enrolment rates.</p><p><strong>Conclusions: </strong>The findings reveal that more than two-thirds of patients were enrolled with a primary care provider or practice; enrolment was influenced by demographic, geographic, socioeconomic, and clinical factors. Lower enrolment among men, recent immigrants, individuals living in large urban/metropolitan areas, lower socioeconomic groups, and those with certain health conditions may indicate potential barriers to health service access and opportunities for enrolment. Addressing these disparities is essential to promote equitable access and enhance opportunities for continuity and coordination of primary care.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"76"},"PeriodicalIF":2.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing SGLT2 inhibitor and GLP-1 RA prescribing in high-risk patients with diabetes: a Department of Veterans Affairs quality improvement intervention.","authors":"Shira Yun, Kathryn Hurren, Rob Holleman, Mandi Klamerus, Adam Tremblay, Jeremy B Sussman","doi":"10.1186/s12875-025-02709-0","DOIUrl":"10.1186/s12875-025-02709-0","url":null,"abstract":"<p><strong>Introduction: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium glucose cotransporter-2 (SGLT2) inhibitors have dramatic clinical benefits, but many appropriate patients do not receive them. We developed a quality improvement (QI) intervention to increase the adoption of these drugs in patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), and/or heart failure (HF). The purpose of this study was to examine whether the intervention increased the use of SGLT2 inhibitors and GLP-1 RAs.</p><p><strong>Methods: </strong>The intervention included: (1) education, academic detailing (1:1 pharmacist to clinician coaching), and audit and feedback directed at providers and allied health professionals at the Veterans Affairs Ann Arbor Healthcare System (VAAAHS); (2) outreach and inreach to patients with T2D and ASCVD, CKD, and/or HF who were not on GLP-1 RAs or SGLT2 inhibitors at baseline. Patients were identified and outcomes evaluated using existing VA national reports. We performed a difference-in-difference analysis of the change in GLP-1 RA and SGLT2 inhibitor prescribing rates before, during, and after the intervention, comparing rates in VAAAHS to rates in the same VA region (called a Veterans Integrated Service Network (VISN)) and the VA nationally to determine whether the rates of prescribing increased faster in VAAAHS than the VISN or VA nationally.</p><p><strong>Results: </strong>Home telehealth nurses and clinical pharmacy practitioners (CPPs) provided outreach to 445 patients; 48% (n = 215) of whom initiated SGLT2 inhibitors or GLP-1 RAs. Four CPPs provided 101 academic detailing sessions to 72 providers. Prior to the intervention, the prescribing rate was 22.7% in VAAAHS, 20.3% in the VISN 10 region, and 18.7% in VA nationally. At the end of the 12-month intervention, the prescribing rate had increased to 37.9% in VAAAHS, 28.4% in the VISN 10 region, and 26.5% in VA nationally. Six-months post-intervention, the prescribing rate continued to increase to 42.4% in VAAAHS, 32.2% in the VISN 10 region, and 30.2% in VA nationally. The rate of prescribing growth in VAAAHS was significantly faster than in the VISN or VA nationally (p < 0.001).</p><p><strong>Conclusion: </strong>Our multidisciplinary QI intervention increased SGLT2 inhibitor and GLP-1 RA prescribing approximately 8% points faster than the national average.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"78"},"PeriodicalIF":2.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence (AI) and the future of Iran's Primary Health Care (PHC) system.","authors":"Reza Dehnavieh, Sohail Inayatullah, Farzaneh Yousefi, Mohsen Nadali","doi":"10.1186/s12875-025-02773-6","DOIUrl":"10.1186/s12875-025-02773-6","url":null,"abstract":"<p><strong>Objective: </strong>The rapid adoption of Artificial Intelligence (AI) in health service delivery underscores the need for awareness, preparedness, and strategic utilization of AI's potential to optimize Primary Health Care (PHC) systems. This study aims to equip Iran's PHC system for AI integration by envisioning potential futures while addressing past challenges and recognizing current trends.</p><p><strong>Method: </strong>This study developed a conceptual framework based on the \"Future Triangle\" (FT) and the \"Health Systems Governance\" (HSG) models. This framework delineates the characteristics associated with the 'pulls on the future' for desired and intelligent PHC, as identified by a panel of experts. Additionally, the 'weights of the past'-referring to the challenges faced by Iran's PHC system in utilizing AI-, and the 'push of the present'-which captures the impacts of AI implementation in global primary care settings-were extracted through a review of relevant literature. The integration and analysis of the collected evidence facilitated the formulation of a range of potential future scenarios, including both optimistic and pessimistic scenarios.</p><p><strong>Findings: </strong>The interaction between the three elements of the FT will shape the future states of Iran's PHC, whether optimistic or pessimistic. Building an optimistic scenario for an AI-driven PHC system necessitates addressing past challenges, including deficiencies in the referral and family doctor systems, the absence of evidence-based decision-making, neglect of essential community health needs, fragmented service delivery, high provider workload, and inadequate follow-up on the health status of service recipients. Consideration must also be given to the current impacts of AI in primary care, including comprehensive, coordinated, and need-based service delivery with systematic and integrated monitoring, quality improvement, early disease prevention, precise diagnosis, and effective treatment. Furthermore, fostering a shared vision among stakeholders by defining and advocating for a future system characterized by foresight, resilience, agility, adaptability, and collaboration is essential.</p><p><strong>Conclusion: </strong>Envisioning potential future states requires a balanced consideration of the influence of past, present, and future, recognizing the dual potential of AI to drive either positive or negative outcomes. Achieving the optimistic future or the \"utopia of intelligent PHC\" and avoiding the pessimistic future or the \"dystopia of intelligent PHC\" requires coherent planning, attention to the tripartite considerations of the future, past, and present, and a clear understanding of the roles, expectations, and needs of stakeholders.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"75"},"PeriodicalIF":2.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitude and practice of family physicians towards physical examination of patients of the opposite gender in primary health care centres in the Kingdom of Bahrain: a qualitative exploratory study.","authors":"Batool AlHejairi, Khalid Afifi, Haya Rashed, Ghadeer Aman, Mai Zaber, Basheer Makarem, Afif Ben Salah, Mohamed Shaikh Ali, Jamil Ahmed","doi":"10.1186/s12875-025-02776-3","DOIUrl":"10.1186/s12875-025-02776-3","url":null,"abstract":"<p><strong>Background: </strong>Physician attitudes towards patients of opposite genders may determine a lack of comprehensive care during patient encounters in primary care, and this has not been previously documented in the Arab Gulf region. This study investigated the attitudes and practices of family physicians about physical examinations of patients of the opposite gender in the Kingdom of Bahrain, specifically identifying barriers to performing physical examinations on patients of the opposite gender.</p><p><strong>Method: </strong>Qualitative exploratory, in-depth interviews were conducted with 15 board-certified Bahraini family physicians at nine primary health care centres from all five regions of the Kingdom of Bahrain. The participants were selected by a purposive sampling designed to include all physicians eligible as per inclusion criteria. A semi-structured interview guide was used for the interviews in English (appendix.1). Interviews were recorded and transcribed verbatim. The data were analysed by thematic analysis.</p><p><strong>Results: </strong>The study revealed four distinct and interrelated themes, including: 1) Influencers affect the practice of performing physical examinations on patients of opposite genders; 2) Effective communication and rapport-building with patients of the opposite gender before physical examination; 3) Physicians collaborate in the physical examination of patients of the opposite gender when needed; 4) Importance of a functional chaperone system in the primary health care centres to provide optimal care.</p><p><strong>Conclusions: </strong>Family physicians identified cultural, religious, and medico-legal barriers to performing physical examinations on opposite-gender patients. They reported adapting to these challenges by finding workarounds, such as referring patients to physicians of the same gender or using a chaperone system. To address these challenges effectively, establishing a regular chaperone system and trainings on examination techniques may enhance physicians' skills and confidence in conducting physical examinations on opposite-gender patients.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"77"},"PeriodicalIF":2.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of a specialized memory clinic supporting primary care providers in a safety net health system.","authors":"Elizabeth Bartelt Joe, Freddi Segal-Gidan","doi":"10.1186/s12875-025-02770-9","DOIUrl":"10.1186/s12875-025-02770-9","url":null,"abstract":"<p><strong>Background: </strong>Although most dementia care occurs in primary care, consultation with dementia specialty care is sometimes indicated. Access to dementia specialists is limited, particularly in resource-limited environments such as the public health safety net, which may require triaging referrals to preserve access for patients with needs that can not be met in a primary care setting.</p><p><strong>Methods: </strong>The eConsult system for primary care providers to refer patients to a subspecialty memory clinic is described for a large safety net health system. Demographic and clinical characteristics are presented for patients evaluated within the memory clinic setting compared to the health system overall. ICD-10-CM codes were used to identify cognitive diagnoses and medical comorbidities. Chi-squared tests were used to compare categorical variables and t-tests for continuous variables.</p><p><strong>Results: </strong>94 individuals age 50 or older were seen in the memory clinic in 2019, of whom 43 were new evaluations. The most common visit diagnoses for new memory clinic patients were Alzheimer's disease (33%), no cognitive diagnosis (28%), unspecified dementia (19%), and mild cognitive impairment (12%); for follow up patients, the most common diagnoses were Alzheimer's disease (49%), unspecified dementia (18%), no cognitive diagnosis (14%), and mild cognitive impairment (10%). For those without a cognitive diagnosis, common visit diagnoses included cognitive symptoms, mood or sleep disorders, and metabolic disturbances. Of the 11 new internal referrals with a prior coded diagnosis of dementia, median time from first diagnosis to their initial memory clinic visit was 224 days.</p><p><strong>Conclusions: </strong>Despite clear systemwide parameters for referral and extensive pre-referral screening via an eConsult system, the most common diagnosis for memory clinic patients was Alzheimer's disease. Direct studies of eConsult are needed to determine primary care providers' needs when referring patients with dementia to a memory clinic setting.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"74"},"PeriodicalIF":2.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the effectiveness and cost-effectiveness of the chronic disease co-care (CDCC) Pilot Scheme: a study protocol.","authors":"Ivy L Mak, Kiki S N Liu, Zoey C T Wong, Vivian Y H Xu, Esther Y T Yu, Tony K H Ha, William C W Wong, Emily T Y Tse, Linda Chan, Amy P P Ng, Edmond P H Choi, Martin Roland, David Bishai, Cindy L K Lam, Eric Y F Wan","doi":"10.1186/s12875-025-02765-6","DOIUrl":"10.1186/s12875-025-02765-6","url":null,"abstract":"<p><strong>Background: </strong>The Chronic Disease Co-Care (CDCC) Pilot Scheme is a government-subsidized program that aims to provide targeted copayment for the screening and management of hypertension, diabetes mellitus and pre-diabetes in the private healthcare sector. Studies have found that concurrent screening and management with a multi-disciplinary intervention is cost-saving because of the reduction in the rates of premature mortality, complications and utilization of public health services. This study aims to evaluate the quality of care, acceptability, effectiveness and cost-effectiveness of the CDCC Pilot Scheme.</p><p><strong>Methods: </strong>Quality of care will be evaluated by the standards achieved by the program in each criterion in the domains of structure, process and outcomes of care. Site visits and two serial questionnaire surveys at 6 and 12 months will be conducted for the structure of care. Operational data, including the provision of diagnosis and treatment, as well as participants' health status will be extracted to evaluate the process and outcomes of care. Participants' acceptability will be evaluated on experience (accessibility, facility, continuity of care and communication), satisfaction (perceived usefulness, continuation and recommendation) and enablement in 548 CDCC participants at 3 and 12 months by telephone surveys. Evaluation of the effectiveness and cost-effectiveness is a 1-year comparative cohort study using longitudinal data on changes in disease control parameters between CDCC and non-CDCC participants at baseline and 12 months. Costing questionnaires on the set-up and operation costs of the Scheme among service providers, and direct medical costs incurred from public and private service utilization among participants within 12 months from enrolment will be assessed. The incremental costs incurred for an additional participant in the CDCC Pilot Scheme to achieve target disease control outcomes after 12 months will be reported as an indicator for cost-effectiveness.</p><p><strong>Discussion: </strong>The quality of care and effectiveness of the CDCC Pilot Scheme in enhancing the health outcomes of the Scheme participants will be examined. Standards of good practice and recommendations for quality enhancement will be established to inform service planning in similar cross-sector screening and management programme.</p><p><strong>Trial registration: </strong>NCT06310148; 2024-03-22.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"73"},"PeriodicalIF":2.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the impact of attachment to primary care and unattachment duration on healthcare utilization and cost in Ontario, Canada: a population-based retrospective cohort study using health administrative data.","authors":"Jonathan Fitzsimon, Shawna Cronin, Anastasia Gayowsky, Antoine St-Amant, Lise M Bjerre","doi":"10.1186/s12875-025-02771-8","DOIUrl":"10.1186/s12875-025-02771-8","url":null,"abstract":"<p><strong>Background: </strong>Insufficient access to primary care remains a major public health issue in Ontario, Canada, particularly for unattached residents (i.e., those who are not formally enrolled with a primary care provider, usually a family physician or occasionally a nurse practitioner). This study evaluates healthcare utilization and costs among unattached individuals, focusing on the impact of unattachment duration.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study using health administrative data, comparing provincially insured residents who maintained a consistent attachment status over the 12-month period (April 1, 2021, to March 31, 2022) to those who were unattached. We employed multivariable regression analyses to examine the associations between attachment status, duration of unattachment, demographic and patient health characteristics, and healthcare utilization and costs.</p><p><strong>Results: </strong>Prolonged periods of unattachment to primary care were significantly associated with increased healthcare costs, particularly in populations with a higher burden of comorbidities. In the context of healthcare costs, attached residents with low comorbidities had a median cost of $287, increasing to $3,711 (cost ratio: 12.93, CI: 12.86-13.01, p < 0.0001) for those with high comorbidities. Unattached individuals with low comorbidities had a median cost of $238 (cost ratio: 0.83, CI: 0.82-0.83, p < 0.0001), rising to $7,106 (cost ratio: 24.76, CI: 24.27-25.26, p < 0.0001) for high comorbidities, and up to $8,177 (cost ratio: 28.49, CI: 26.61-30.49, p < 0.0001) for long-term unattached with high comorbidities.</p><p><strong>Conclusions: </strong>Our findings underscore the substantial impact of long-term unattachment on both individual patients and the healthcare system, with higher levels of chronic disease further exacerbating these effects. These results are crucial for shaping programs and policies to maximize their impact on reducing emergency department visits, hospitalizations, and overall healthcare costs.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"26 1","pages":"72"},"PeriodicalIF":2.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}